| Meniscus Transplantation Rehabilitation Protocol |
| General Considerations: Partial weight-bearing status for 4 weeks post-op. 10-20% toe-touch for 1-2 weeks, progress as tolerated. Most patients will be in a hinged rehab brace locked in full extension for 4 weeks post-op unless otherwise indicated. Regular assessment of gait to avoid compensatory patterns. Regular manual mobilizations to surgical wounds and associated soft tissue to decrease the incidence of fibrosis. No resisted leg extension machines (isotonic or isokinetic). No high impact or cutting/twisting activities for at least 4 months post-op. MD follow-up visits at Day 1, Day 8 - 10, 1 month, 4 months, 6 months, and 1 year post-op. During the first 4 Weeks: TWICE PER DAY: Without brace and seated with feet off the ground, gently bend knee back as tolerated BUT NO MORE THAN 90° for a good knee stretch without increase in pain. Relax knee and stretch for 60 seconds. Week 1: MD visit Day 1 post-op to change dressing and review home program. Icing and elevation regularly. Aim for 5x per day, 15 - 20 minutes each time. Ice machine: Use as directed. Exercises 1) Straight leg raise exercises (lying, seated, and standing): quadriceps/adduction /abduction/gluteal sets. 2) Twice daily passive and active range of motion exercises. 3) Theraband calf presses. 4) Well-leg stationary cycling. 5) Upper body training. 6) Core/trunk training. Soft tissue treatments to musculature for edema and pain control. Manual daily patella glides up/down/side-to-side by therapist and patient. Weeks 2 - 4: Clinic visit at 8 - 10 days for suture removal and check-up. GENTLE and BRIEF pool/deep water workouts after the first 8 - 10 days and with the use of a brace. No more than 30 minutes per workout; no more than 3 workouts per week. Continue with pain control, gentle range of motion, and soft tissue treatments. Weeks 4 - 6: MD visit at 4 weeks post-op; will progress to full weight bearing and discontinue use of rehab brace. Increase stretching and manual treatments to improve knee range of motion. Extension should be full, and flexion should be near 100°. Incorporate functional exercises (i.e. partial squats, calf raises, mini-step-ups, light leg pressing, proprioception). Stationary bike and progressing to road cycling as tolerated. Slow walking on treadmill for gait training; preferably a low-impact treadmill. Gait training to normalize movement patterns. Weeks 6 - 8: Increase the intensity of functional exercises (i.e. cautiously increase depth of closed-chain exercises, Shuttle/leg press). Do not overload closed- or open-chain exercises. Continue to emphasize normal gait patterns. Range of motion: Extension full, and flexion to 120°. Weeks 8 - 12: Add lateral training exercises (side step-ups, Theraband resisted side-stepping, lateral stepping). Introduce more progressive single-leg exercise. Patients should be pursuing a home program with emphasis on sport/activity-specific training. Range of motion should be near normal. Weeks 12 - 16: Low-impact activities until 16 weeks. Increasing intensity of strength and functional training for gradual return to activities. NOTE: All progressions are approximations and should be used as a guideline only. Progression will be based on individual patient presentation, which is assessed throughout the treatment process. |
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